HomeMy WebLinkAbout01-19-06
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
k / f\ k YVOIJ /Llf ____~~ ___ _
DATE OF DEATH (MM-DD-YEAR) J DATE OF BIRTH. (MM-DD-YEAR) ._
_ _ OJ I L _4 / -z. op r ___ ___ _ _ 09 / I ~ _L'iJ-_ 5____~__~
(IF APPLICABLE) tRl/lVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
IJ ,4
~ 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach ropy of Wil)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of dea" after 12-12-82)
o 7. Decedent Maintained a Living Trust (AI1ach ropy of Trust)
o 10. Spousal Poverty Credit (date of dealh between 12-31-91 and 1-1-95)
FilE NUMBER
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NUMBER
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
201 - It JbB2..
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THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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o 3. Remainder Return (date of dea" prior to 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sell 0)
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NAMEu __J Al1~fL 11 "_--'< J l:. Je. COMPLET~ =~NG ~~:~Sp If. V fI Lv A r
FIRM NAME (If Applicable) ,/ a
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(11) -0-
(12) 2.// OJ2.0(
(13) - el-
(14) '2'7 03'2. d&
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x .0 (15)
xO 'I> (16) /2./C . V Lf
x12 (17) - (,I -
x .15 (18) -Cj
(19) / '2...)" 'iLl
TELEPHONE NUMBER ...
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1) -(;-
(2) -l/-
(3) , 0-
(4) 'D-
(5) 27032. de
(6) - 0-
(7) -0 ~
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposils & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (lotal Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
(10)
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10. Debls of Decedent, Morlgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15 Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(12)
16. Am04nl of Line 14 taxable at lineal rale
2.? (1]2 . "C
17. Amount of Line 14 taxable al sibling rate
18. Amount of Line 14 taxable at collateral rale
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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SiRE.EfAi.iDRESS
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Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
CITY
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(1)
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3.
InteresUPenalty if applicable
D. Interest
E. Penalty
Total Credits ( A + B + C ) (2)
,0-
-6-
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4.
TotallnteresUPenalty ( D + E )
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Make Check Payable to: REGISTER OF WILLS, AGENT
(3) -0-
(4) - (; -
(5) I 2~ Ie, Y LJ
(SA) ---0-
(58) I ZI '- 4'/
5.
If Line 1 + Line 3 is greater than Line 2, enter the differen~. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
c. retain a reversionary interest; or.......................................................................................................................... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0
Under penahies of perjury. I declare that I have examined this return. including accompanying schedules and statements, and to the best of my knowledge and belief. ij is true. correct and complete.
I Declaration of preparer other lhan the personal representative is based on al information of which preparer has any knowledge.
SIGN~r:~SIW'NGR8URN
ADDRESS
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SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
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ADDRESS
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For dates of death on or after July 1, 1994 and before January 1, 1995, the tax I
[72 P.S. ~9116 (a) (1.1) (i)J.
For dates of death on or after January 1, 1995, the tax rate imposed on the
The statute does not exempt a transfer to a surviving spouse from tax, and I
the surviving spouse is the only beneficiary.
ansfers to or for the use of the surviving spouse is 3%
e use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)J.
;fosure of assets and filing a tax retum are still applicable even if
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child tw
Jr a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)J.
rhe tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.070, except as noted in 72 P.S. ~9116(1.2) 172 P.S. ~9116(a)(1)J.
'he tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 PS. ~9116(a)(1.3)J. A sibling is defined, under Section 9102, as an
1dividual who has at least one parent in common with the decedent, whether by blood or adoption.
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. at death to or for the use of a natural parent, an adoptive parent,